POS0712 WHAT IS THE OUTCOME OF PATIENTS WITH OR WITHOUT SUBCLINICAL GIANT CELL ARTERITIS IN POLYMYALGIA RHEUMATICA? PRELIMINARY DATA OF AN OBSERVATION STUDY
Authors: E. De Miguel, R. Karalilova, P. Macchioni, C. Campochiaro, C. Ponte, E. Conticini, S. Cowley, S. Monti, I. Monjo, Z. Batalov, G. Klinowski, P. Falsetti, D. Kane, A. Tomelleri, A. Hocevar
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> Subclinical giant cell arteritis (GCA) in polymyalgia rheumatica (PMR) is found in the 22.8% of patients on ultrasound examinations. The outcome and the optimal management of subclinical giant cell arteritis (GCA) in patients with polymyalgia rheumatica (PMR) have not been defined yet. <h3>Objectives</h3> The aim of this study was to investigate the short-term outcome of PMR patients with concurrent subclinical GCA that were included in our multicenter project on the prevalence, characteristics and outcome of subclinical GCA (diagnosed by vascular ultrasound) in PMR <sup>[1]</sup>. <h3>Methods</h3> We analyzed follow up data at 3, 6, 12 and 18 months of consecutive PMR patients from 7 European rheumatology centers. All patients fulfilled 2012 EULAR/ACR Provisional Classification Criteria for Polymyalgia Rheumatica and they had not symptom of clinical GCA. Patients were stratified into two groups: pure PMR and PMR with subclinical GCA, and the outcome between these two groups were compared. A relapse was defined as clinical and/or laboratory worsening of the disease after the initial remission and minor and major relapse EULAR definition was used <sup>[2]</sup>. <h3>Results</h3> We included 116 PMR patients (47 with concurrent subclinical GCA and 69 with pure PMR) followed for a median (IQR) of 21 (17; 23) months. We observed relapses in 35/116 patients (30.2%), 27/47 (57.4%) in PMR with subclinical GCA and 8/69 (11.6%) in pure PMR group (p&lt;0.001). All relapses in the pure PMR group were minor relapses, whereas we observed 2 major relapses in the subclinical GCA group. The dose of corticosteroids used at the baseline visit was significantly higher in the GCA subclinical group, but tapering of steroids occurred faster than recommended by clinical guidelines <sup>[2]</sup>. Prednisone dose was significantly higher in patients with PMR and subclinical GCA than in patients with pure PMR both at baseline and at month 6 (Table 1). In patients with PMR with subclinical GCA mean starting dose of prednisone was 32.2±16.1 mg in those who relapsed and 36.2±12.8 in those who maintained remission (p=0.166); at 3 months, it was 13.2±7.1 and 18.2±7.9, respectively (p&lt;0.05). Three patients in the PMR with subclinical GCA group received biological therapy at diagnosis; one of them had a minor relapse. <h3>Conclusion</h3> PMR patients with subclinical GCA had a significantly higher number of relapses during the follow-up than pure PMR group. These results suggest that subclinical GCA in PMR should be treated in the same manner as clinically overt GCA. <h3>References</h3> [1]De Miguel et al. Prevalence of subclinical giant cell arteritis in patients with polymyalgia rheumatica. Ann Rheum Dis 2022; volume 81, supplement 1, page 122. [2]Hellmich B et al. 2018 Update of the EULAR recommendations for the management of large vessel vasculitis. Ann Rheum Dis. 2020 Jan;79:19-30. <h3>Acknowledgements</h3> We would like to thank to the GCA/PMR study group for her contributions to the development of collaborative studies. <h3>Disclosure of Interests</h3> None Declared.